What to do if asthma worsens despite inhalers in the elderly?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

As you already described, your father is suffering from bronchial asthma (it is caused by inflammation and muscle tightening around the airways, which makes it harder to breathe).

The key to treating asthma is the use of inhaled medications. For adequate asthma control, appropriate inhalers with the right dose are to be used with the appropriate technique, and they should be used regularly.

Investigations to be done on newly diagnosed or uncontrolled bronchial asthma, if not done previously, are:

Causes for repeated exacerbations include:

1. The presence of comorbid conditions like allergic rhinitis (an allergic reaction that causes sneezing, congestion, and sore throat), GERD (gastroesophageal reflux disease is a common condition in which the stomach contents move up into the esophagus), and obesity (a complex chronic disease that is characterized by too much body fat).

2. Incorrect inhaler technique or if the inhaler is not being used regularly.

3. If incorrect inhaled medicines are being used.

Regarding biologics in asthma: Biologics are a newer type of medication used to treat asthma, especially for people whose asthma is hard to control with regular inhalers (only if inhalers have been used regularly in the correct fashion).

In asthma, the airways become inflamed, making it hard to breathe. Biologics work by reducing inflammation.

Most biologics are administered by injection, either at a healthcare facility or at home after training. Some may be given every few weeks or monthly, depending on the medication.

The benefits are:

1. Fewer attacks: Many patients experience fewer asthma attacks and better control over their symptoms.

2. Improved quality of life: With better control, patients often find they can participate more in daily activities and enjoy life more fully.

Considerations to have in mind are:

1. Cost: Biologics can be expensive.

2. Side Effects: Some people may experience side effects like injection site reactions, headaches, or an increased risk of infections.

Biologics can be a game-changer for individuals with severe asthma. If your father is struggling with his asthma, discussing the possibility of biologics with his doctor may lead to better management and improved quality of life.

But keep in mind, they shall be only used if asthma is not controlled, even after using inhalers regularly in the correct manner.

Other more essential advice to follow:

1. Start regularly using inhalers (MDI (metered dose inhaler) Budesonide, Formoterol (200/6) (two puffs twice daily with a spacer followed by mouthwash). Inhalers are to be used daily without any break for at least six months. No dose is to be skipped unless advised by the pulmonologist.

2. Mac spacer (it is to be attached to the inhaler; the technique of its usage can be learned online in videos).

3. Consult a pulmonologist either physically or virtually regularly (at least once monthly).

4. Take vaccinations appropriate for the age if not taken already.

5. Control of comorbid conditions, if any, like allergic rhinitis, since uncontrolled allergic rhinitis and GERD often exacerbate asthma, leading to poor asthma control.

6. Ensure he has a written asthma action plan that outlines how to manage his symptoms and what to do in an emergency. This can help him feel more in control.

7. Avoid triggers: Identifying and avoiding triggers (like smoke, pollution, pets, or certain foods) can significantly improve his condition.

8. Pulmonary rehabilitation: Some programs offer education and exercises to improve lung function and overall fitness.

9. Lifestyle changes: Regular exercise (as tolerated), maintaining a healthy diet, and managing stress can all contribute to better asthma control.

10. Monitoring and technology: Using a peak flow meter to monitor his lung function can help him detect worsening asthma early. There are also smartphone apps that can help track symptoms and medication use.

11. Emergency preparedness: Make sure he has an emergency plan in place, including access to emergency medications and knowing when to seek urgent care.

Get all the investigations and follow up after one week with investigations. We will then evaluate if his asthma is controlled or not.

Kindly consult a physician, discuss with them, and start taking the medications with their consent.

I hope this information will help you.

Kindly revert in case of queries.

Thank you.